Quantitative Measurement of Pneumothorax Using Artificial Intelligence Management Model and Clinical Application.

Artificial intelligence (AI) techniques can be a solution for delayed or misdiagnosed pneumothorax. This study developed, a deep-learning-based AI model to estimate the pneumothorax amount on a chest radiograph and applied it to a treatment algorithm developed by experienced thoracic surgeons. U-net performed semantic segmentation and classification of pneumothorax and non-pneumothorax areas. The pneumothorax amount was measured using chest computed tomography (volume ratio, gold standard) and chest radiographs (area ratio, true label) and calculated using the AI model (area ratio, predicted label). Each value was compared and analyzed based on clinical outcomes. The study included 96 patients, of which 67 comprised the training set and the others the test set. The AI model showed an accuracy of 97.8%, sensitivity of 69.2%, a negative predictive value of 99.1%, and a dice similarity coefficient of 61.8%. In the test set, the average amount of pneumothorax was 15%, 16%, and 13% in the gold standard, predicted, and true labels, respectively. The predicted label was not significantly different from the gold standard (p = 0.11) but inferior to the true label (difference in MAE: 3.03%). The amount of pneumothorax in thoracostomy patients was 21.6% in predicted cases and 18.5% in true cases.

Detecting Bacterial Biofilms Using Fluorescence Hyperspectral Imaging and Various Discriminant Analyses.

Biofilms formed on the surface of agro-food processing facilities can cause food poisoning by providing an environment in which bacteria can be cultured. Therefore, hygiene management through initial detection is important. This study aimed to assess the feasibility of detecting Escherichia coli (E. coli) and Salmonella typhimurium (S. typhimurium) on the surface of food processing facilities by using fluorescence hyperspectral imaging. E. coli and S. typhimurium were cultured on high-density polyethylene and stainless steel coupons, which are the main materials used in food processing facilities. We obtained fluorescence hyperspectral images for the range of 420-730 nm by emitting UV light from a 365 nm UV light source. The images were used to perform discriminant analyses (linear discriminant analysis, k-nearest neighbor analysis, and partial-least squares discriminant analysis) to identify and classify coupons on which bacteria could be cultured. The discriminant performances of specificity and sensitivity for E. coli (1-4 log CFU·cm-2) and S. typhimurium (1-6 log CFU·cm-2) were over 90% for most machine learning models used, and the highest performances were generally obtained from the k-nearest neighbor (k-NN) model. The application of the learning model to the hyperspectral image confirmed that the biofilm detection was well performed. This result indicates the possibility of rapidly inspecting biofilms using fluorescence hyperspectral images.

Unusual presentation of granulomatosis with polyangiitis causing periaortitis and consequent subclavian steal syndrome: A case report.

BACKGROUND: Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease that involves small-to-medium-sized vessels and forms necrotizing vasculitis with granulomatous inflammation. The formation of a large vessel lesion in GPA patients has been scarcely reported, and it can cause confusion in the diagnosis. CASE SUMMARY: A 27-year-old man presented with mild left-sided pleuritic chest pain that started one year prior. An imaging study revealed up to 2.5 cm-sized two irregular nodular consolidation nodule in the left lower lobe. Both nodules showed central necrosis. Also, there was a periaortic mass occluding the branching porting of the subclavian artery. He had positive anti-neutrophil cytoplasmic antibodies (ANCAs), but myeloperoxidase-ANCAs and proteinase 3-ANCAs were negative. The patient also developed symptoms of subclavian vein syndrome during the follow-up. Wedge resection of the lung revealed necrotizing vasculitis, destructive parenchymal abscess and surrounding granuloma, and therefore diagnosed of GPA. The patient started on methotrexate and steroid therapy with a relief of symptomatic. CONCLUSION: Here, we present an unusual manifestation of GPA with periaortitis and consequent subclavian steal syndrome, which has never been previously described. This case alerts us that we should include GPA in the differential diagnosis of large vessel vasculitis as well as subclavian steal syndrome.

Novel Pathologic Factors for Risk Stratification of Gastric "Indefinite for Dysplasia" Lesions.

METHODS: In total, 123 IND cases with final diagnoses of cancer (29.3%), high-grade dysplasia (6.5%), low-grade dysplasia (11.4%), and nonneoplasm (52.8%) were randomly divided into test set (n = 27) and validation set (n = 96). By the image analysis, size, pleomorphism, hyperchromasia, irregularity of nuclei, and ratios of structural atypia area (SAA) to total IND area were measured in the test set. Using the validation set, consensus meetings were held for the evaluation of pathologic factors that predict the final diagnosis. RESULTS: By image analysis, the only ratio of SAA to total IND area was associated with the final diagnosis (p < 0.001). In the consensus meeting for validation, the nuclear factors, except loss of nuclear polarity (p = 0.004-0.026), could not predict the final diagnosis. Conversely, most structural factors could predict the final diagnosis. In particular, SAA > 25% was the most powerful predictive factor. We proposed criteria of risk stratification by using SAA > 25%, loss of surface maturation (LOSM), and loss of nuclear polarity (LONP) (Malignancy rate; Category 0: SAA ≤ 25% without LOSM and LONP; 0%, Category 1: SAA ≤ 25% with any of LOSM or LONP; 15.2%-16.7%, Category 2: SAA > 25% without LOSM and LONP; 44.4%-50.0%, Category 3: SAA > 25% with any of LOSM or LONP 54.5%-55.6%). CONCLUSIONS: Structural atypia was more helpful than nuclear atypia and SAA > 25% was the most powerful predictor for the diagnosis of INDs of the stomach. We propose shortening the follow-up period to six months for Category 1, endoscopic resection for Category 2 and 3, postresection follow-up periods of one year for Category 2, and six months for Category 3.

Nozzle-Jet-Printed Silver/Graphene Composite-Based Field-Effect Transistor Sensor for Phosphate Ion Detection.

High concentration of dissolved phosphate ions is the main responsible factor for eutrophication of natural water bodies. Therefore, detection of phosphate ions is essential for evaluating water eutrophication. There is a need at large-scale production of real-time monitoring technology to detect phosphorus accurately. In this study, facile enzymeless phosphate ion detection is reported using a nozzle-jet-printed silver/reduced graphene oxide (Ag/rGO) composite-based field-effect transistor sensor on flexible and disposable polymer substrates. The sensor exhibits promising results in low concentration as well as real-time phosphate ion detection. The sensor shows excellent performance with a wide linear range of 0.005-6.00 mM, high sensitivity of 62.2 µA/cm2/mM, and low detection limit of 0.2 µM. This facile combined technology readily facilitates the phosphate ion detection with high performance, long-term stability, excellent reproducibility, and good selectivity in the presence of other interfering anions. The sensor fabrication method and phosphate detection technique yield low-cost, user-friendly sensing devices with less analyte consumption, which are easy to fabricate on polymer substrates on a large scale. Besides, the sensor has the capability to sense phosphate ions in real water samples, which makes it applicable in environmental monitoring.

Preparation of a Highly Conductive Seed Layer for Calcium Sensor Fabrication with Enhanced Sensing Performance.

The seed layer plays a crucial role in achieving high electrical conductivity and ensuring higher performance of devices. In this study, we report fabrication of a solution-gated field-effect transistor (FET) sensor based on zinc oxide nanorods (ZnO NRs) modified iron oxide nanoparticles (α-Fe2O3 NPs) grown on a highly conductive sandwich-like seed layer (ZnO seed layer/Ag nanowires/ZnO seed layer). The sandwich-like seed layer and ZnO NRs modification with α-Fe2O3 NPs provide excellent conductivity and prevent possible ZnO NRs surface damage from low pH enzyme immobilization, respectively. The highly conductive solution-gated FET sensor employed the calmodulin (CaM) immobilization on the surface of α-Fe2O3-ZnO NRs for selective detection of calcium ions (Ca2+). The solution-gated FET sensor exhibited a substantial change in conductance upon introduction of different concentrations of Ca2+ and showed high sensitivity (416.8 µA cm-2 mM-1) and wide linear range (0.01-3.0 mM). In addition, the total Ca2+ concentration in water and serum samples was also measured. Compared to the analytically obtained data, our sensor was found to measure Ca2+ in the water and serum samples accurately, suggesting a potential alternative for Ca2+ determination in water and serum samples, specifically used for drinking/irrigation and clinical analysis.

Fabrication of a solution-gated transistor based on valinomycin modified iron oxide nanoparticles decorated zinc oxide nanorods for potassium detection.

There are considerable interests to detect and monitor the abnormal level of minerals in water for avoiding/preventing any toxic effects after consumption. Herein, we report the fabrication of solution-gated field-effect-transistor (FET) based potassium sensor using iron oxide nanoparticles (Fe2O3 NPs) modified directly grown zinc oxide nanorods (ZnO NRs). The Fe2O3 NPs modification of ZnO NRs provided stability to nanorods surface and improved surface area for valinomycin immobilization. As-fabricated potassium sensor (valinomycin-Fe2O3 NPs-ZnO NRs/SiO2/Si) provided enhanced current response with increasing potassium concentration. During sensing measurements, FET sensor showed high sensitivity (4.65 µA/µM/cm2) in the linear range of 0.1 µM to 125 µM, low limit of detection (∼0.04 µM), good stability, excellent reproducibility, and favorable selectivity. Thus, good sensing performance of the FET based potassium sensor presents it as simple, low-cost, and convenient device for selective detection of potassium in solution.

Synthesis of manganese oxide nanorods and its application for potassium ion sensing in water.

Potassium is an important body mineral that control the cellular and electrical functions in the body. The potassium ion concentration change in human serum causes the risk of acute cardiac arrhythmia. Hence, it is important to monitor the potassium level in drinking water/food to control the intake and prevent its effect. This paper reports synthesis of manganese oxide (MnO2) nanorods using low-temperature sol-gel method for the fabrication of non-enzymatic potassium ion sensor. The detailed investigation of the as-synthesized MnO2 nanorods were carried out using field-emission scanning electron microscopy (FESEM), X-ray diffraction (XRD), and transmission electron microscopy (TEM). The morphological and structural observations revealed that this method yield small nanorods with average length and diameters of about 210 ±â€¯10 nm and 20 ±â€¯3 nm, respectively. Further, as-synthesized α-MnO2 nanorods were used to fabricate non-enzymatic potassium ion sensor following the deposition of α-MnO2 nanorods on glassy carbon electrode (GCE) with the help of conductive binder. The electrochemical characterizations of fabricated non-enzymatic potassium sensor showed good sensing performance (i.e. sensitivity, selectivity, long term stability, and reproducibility). Moreover, applicability of the sensor to detect potassium ion in water samples were also demonstrated.

Fabrication of sensitive non-enzymatic nitrite sensor using silver-reduced graphene oxide nanocomposite.

There are increasing demands of more sensitive sensors for monitoring potential hazards in real water that may cause serious problems to human health. Herein, we report the development of a non-enzymatic nitrite sensor using nanocomposite of reduced graphene oxide decorated with silver nanoparticle (Ag-rGO). First, Ag-rGO nanocomposite was synthesized using a facile and cost-effective microwave-assisted approach. Then, as-synthesized Ag-rGO nanocomposite was used to modify glassy carbon electrode (GCE) and applied for the sensitive and selective detection of nitrite in the aqueous medium with increasing concentration of nitrite. Under optimized conditions, sensor achieved high sensitive response (18.4 µA/µM·cm2) in a wide linear range (0.1-120 µM), low limit of detection (∼0.012 µM), and good selectivity using differential pulse voltammograms (DPV). The applicability of fabricated non-enzymatic nitrite sensor was checked in real sample with satisfactory results.

Application of adipocyte-related antibodies in undifferentiated sarcomas to identify dedifferentiated liposarcomas based on histological and clinical analysis.

BACKGROUND: Due to morphologic similarities between undifferentiated sarcoma (US) and dedifferentiated liposarcoma (DDLPS), some portions of US could be identified as DDLPS. In this study, we applied adipocyte-related antibodies in order to discriminate possible cases of DDLPS from US. MATERIALS AND METHODS: A total of 46 cases, previously diagnosed as US, were examined. Immunohistochemistry for MDM2, CDK4, calreticulin, FABP4, and stathmin were performed. Histological findings were reviewed and clinical data was analyzed retrospectively. RESULTS: MDM2, CDK4, calreticulin, FABP4, and stathmin were positive in 17 (37.0%), 14 (30.4%), 3 (6.5%), 1 (2.2%), and 12 (26.1%) of the total 46 cases, respectively. MDM2/CDK4 positive cases showed more frequent positivity for calreticulin/FABP4/stathmin. Survival analysis, based on staining pattern, revealed a significantly better survival in the group where either MDM2 and CDK4 were positive and at least one of calreticulin, FABP4, or stathmin staining were positive. CONCLUSIONS: We conclude that when either MDM2-positive or CDK4-positive cases show any other positive results for calreticulin, FABP4, or stathmin, they have a significantly better survival and the possibility of DDLPS should be considered. Additional use of calreticulin, FABP4, or stathmin immunohistochemistry helps us to narrow the pool for further studies such as molecular analysis for a definite diagnosis.

Fully nozzle-jet printed non-enzymatic electrode for biosensing application.

The progress in developing the electrochemical sensors for biomolecule detection requires a facile device fabrication method. Herein, we report printing of silver (Ag) precursor and copper oxide nanoparticles (CuO NPs) inks by nozzle-jet technique to fabricate non-enzymatic glucose biosensor on flexible polyethylene terephthalate (PET) substrate. The fully printed CuO NPs/Ag/PET electrodes were characterized using electrochemical techniques for non-enzymatic biosensing of glucose. The fully printed non-enzymatic biosensor exhibited a high sensitivity (1424.2 µA mM-1 cm-2), linear range from 0.1 to 15 mM, low detection limit (0.3 µM; S/N = 3) and fast response time of ∼2 s under a working potential of +0.6 V. Additionally, printed electrodes demonstrated an excellent long term stability, high reproducibility, good selectivity and high accuracy during glucose concentration measurements in human blood and serum samples. These results indicate that the electrode fabrication using nozzle-jet printing can be regarded as a potential technique for the future development of high performance and low cost bio/chemical sensor devices.

Nozzle-jet printed flexible field-effect transistor biosensor for high performance glucose detection.

Printable electronics is a subject of great interest for low-cost, facile and environmentally-friendly large scale device production. But, it still remains challenging for printable biosensor development. Herein, we present the fabrication of nozzle-jet printed flexible field-effect transistor (FET) glucose biosensor. The silver source-drain electrodes and ZnO seed layers were printed on flexible substrate by nozzle-jet printer followed by ZnO nanorods (ZnO NRs) synthesis and glucose oxidase (GOx) immobilization. Utilization of nozzle-jet printing methods resulted in highly reproducible electrodes with well-defined vertical grown ZnO NRs for high GOx loading and enhanced glucose sensing performance in a wide glucose detection range. The stability, anti-interference ability, reproducibility, reusability, and applicability in human serum samples were also assessed. Overall, biosensor fabrication using nozzle-jet printer will not only provide large scale production of highly reproducible electrodes but also reduce the fabrication cost. Additionally, printed electrodes can be modified accordingly for different analyte detection.

Highly Efficient Non-Enzymatic Glucose Sensor Based on CuO Modified Vertically-Grown ZnO Nanorods on Electrode.

There is a major challenge to attach nanostructures on to the electrode surface while retaining their engineered morphology, high surface area, physiochemical features for promising sensing applications. In this study, we have grown vertically-aligned ZnO nanorods (NRs) on fluorine doped tin oxide (FTO) electrodes and decorated with CuO to achieve high-performance non-enzymatic glucose sensor. This unique CuO-ZnO NRs hybrid provides large surface area and an easy substrate penetrable structure facilitating enhanced electrochemical features towards glucose oxidation. As a result, fabricated electrodes exhibit high sensitivity (2961.7 µA mM-1 cm-2), linear range up to 8.45 mM, low limit of detection (0.40 µM), and short response time (<2 s), along with excellent reproducibility, repeatability, stability, selectivity, and applicability for glucose detection in human serum samples. Circumventing, the outstanding performance originating from CuO modified ZnO NRs acts as an efficient electrocatalyst for glucose detection and as well, provides new prospects to biomolecules detecting device fabrication.

Florid cystic endosalpingiosis associated with a retroperitoneal leiomyoma mimicking malignancy: a case report.

Florid cystic endosalpingiosis (FCE) is a rare type of endosalpingiosis that presents as a mass-like lesion. Here we report an unusual case of FCE associated with a retroperitoneal leiomyoma. A 46-year old female presented with a palpable abdominal mass. A pelvic CT revealed a 23.5×16.3×9.4 cm sized multilocular cystic and solid mass in the retroperitoneum. Surgical excision of the mass was performed. Microscopically, the cystic spaces were lined by a single layer of ciliated tubal epithelium. The solid areas consisted of thick bundles of spindle cells. There were no cytologic atypia, mitosis or necrosis. The spindle cells were positive for actin and desmin, and were negative for c-kit, CD34, S100 and HMB-45, confirming the diagnosis of FCE associated with retroperitoneal leiomyoma.

Real-Time Analysis of Temperature Changes in Composite Increments and Pulp Chamber during Photopolymerization.

OBJECTIVE: The aim of this study was to evaluate the temperature change at various sites within the composite and on the pulpal side of dentin during polymerization of two composite increments. MATERIALS AND METHODS: Class I cavities prepared in third molars were restored in two composite increments (n = 5). Temperatures were measured for 110 s using eight thermocouples: bottom center of cavity (BC), top center of 1st increment (MC), top center of 2nd increment (TC), bottom corner of cavity (BE), top corner of 1st increment (ME), top corner of 2nd increment (TE), pulpal side of dentin (PD), and center of curing light guide tip (CL). RESULTS: Maximum temperature values (°C) measured during polymerization of 1st increment were MC (59.8); BC (52.8); ME (51.3); CL (50.7); BE (48.4); and PD (39.8). Maximum temperature values during polymerization of 2nd increment were TC 58.5; TE (52.6); MC (51.7); CL (50.0); ME (48.0); BC (46.7); BE (44.5); and PD (38.8). CONCLUSION: Temperature at the floor of the cavity was significantly higher during polymerization of 1st increment compared to 2nd increment. Temperature rise was higher at the center than at the corner and at the top surface than at the bottom surface of each increment.

Relationship between duration of hospital-acquired acute kidney injury and mortality: a prospective observational study.

BACKGROUND/AIMS: New definitions of acute kidney injury (AKI) have recently emerged. Some studies have suggested that duration of AKI is an additional predictive parameter for mortality. Here, we evaluated whether AKI duration was predictive of long-term mortality in patients with hospital-acquired acute kidney injury (HAAKI). METHODS: We prospectively enrolled patients who developed HAAKI at an urban university hospital, from September 2007 to August 2008 and followed them until December 2011. Patients were divided into two groups by duration of the AKI (1 to 5 days vs. ≥ 6 days), and long-term mortality was compared. RESULTS: HAAKI developed in 1.2% of patients during the enrollment period. The median follow-up period was 240 days (interquartile range, 53 to 1,428). In 42.3% of patients (n = 52), the AKI lasted 1 to 5 days, while it lasted ≥ 6 days in 57.7% (n = 71). Survival analysis showed that a longer duration of AKI increased the risk of death. Long-term survival was significantly different in the two groups. CONCLUSIONS: The duration of AKI influenced mortality rates in hospitalized patients. Thus, AKI duration is a parameter affecting mortality in HAAKI.

Identification of EGFR Mutations by Immunohistochemistry with EGFR Mutation-Specific Antibodies in Biopsy and Resection Specimens from Pulmonary Adenocarcinoma.

PURPOSE: Mutation-specific antibodies have recently been developed for identification of epidermal growth factor receptor (EGFR) mutations by immunohistochemistry (IHC). This study was designed to investigate whether the type of specimen (biopsy vs. resection) would make a difference in determining mutation status by IHC, and to evaluate whether biopsies are suitable for detection of mutant EGFR protein. MATERIALS AND METHODS: IHC was performed using mutation-specific antibodies for E746-A750 deletion (DEL) and L858R point mutation (L858R) in biopsies and tissue microarrays of resected tumors from 154 patients with pulmonary adenocarcinoma. Results were then compared with DNA sequencing data. RESULTS: Molecular-based assays detected EGFR mutations in 62 patients (40.3%), including 14 (9.1%) with DEL, and 31 (20.1%) with L858R. IHC with two mutation-specific antibodies showed a homogeneous staining pattern, and correctly identified EGFR mutation status in 89% (137/154). Overall (biopsy/resection) sensitivity, specificity, positive predictive value, and negative predictive value were 75.6% (78.3%/72.7%), 94.5% (90.9%/96.3%), 85% (78.3%/88.9%), and 90.4% (90.9%/89.7%), respectively. CONCLUSION: Our data showed that IHC using EGFR mutation-specific antibodies is useful for detection of EGFR mutations with high specificity and good sensitivity not only for resection specimens but also for biopsy materials. Therefore, IHC using EGFR mutation-specific antibodies may preclude a second biopsy procedure to obtain additional tissues for identification of EGFR mutations by molecular assays in biopsies from advanced cancer, particularly when tumor cells in the samples are limited.

A possible complementary tool for diagnosing tuberculosis: a feasibility test of immunohistochemical markers.

Differentiation of tuberculous granuloma (TG) from non-tuberculous granuloma (NG) is histopathologically difficult. We evaluated the usefulness of selected immunohistochemical markers to differentiate tuberculous granuloma (TG) and non-tuberculous granuloma (NG). We selected six biomarkers (FoxP3, TNF-beta, E-selectin [ESEL], indoleamine 2,3-dioxygenase [IDO], lactoferrin [LACT], and tartrate-resistant acid phosphatase [TRAP]) and immunohistochemically analyzed their expression in the presence of two types of granulomatous tissue samples, TG (n = 36) and NG (n = 31), using a microarray format. Three of those six biomarkers (LACT, IDO, and TNF-beta) were moderately accurate in discriminating TG from NG, individually and in combination, according to ROC analysis (AUC = 0.7-0.89, sensitivity = 55.6-77.8%, specificity = 71.0-100%). Our data indicate that selected immunohistochemical markers (LACT, IDO, and TNF-beta) can be used in ancillary tests to differentiate TG from NG in tissue samples. Further large-scale studies are required to validate our results.

Expression of histone deacetylases in diffuse large B-cell lymphoma and its clinical significance.

BACKGROUND: Histone deacetylase inhibitors are a new class of drugs used in treatment of malignant tumors. Diffuse large B-cell lymphoma (DLBCL) is the most common type of B-cell lymphoma, and it accounts for more than 40% of all B-cell lymphomas. In this study, we aimed to determine the expression patterns of histone deacetylases (HDACs) in DLBCL, to examine whether HDAC expression patterns differ among cases, and to assess whether these findings have clinical significance. MATERIALS AND METHODS: We selected 91 cases of DLBCL diagnosed at St. Vincent Hospital, The Catholic University of Korea, from 2001-2012. We performed a pathology slide review and collected clinical data including age, sex, tumor site, survival time, and mortality. Immunohistochemical analysis was performed using primary antibodies for HDACs, including HDAC1 and 2 of class I, HDAC4 and 5 of class IIa, and HDAC6 of class IIb. Expression site was determined to be nuclear, cytoplasmic, or both. Staining intensities were graded as low and high. We assessed correlations between HDAC expression levels and clinical data and survival analysis. RESULTS: Of the 91 cases examined, 46 (50.5%) were men and 45 (49.5%) were women. Most of the patients were elderly, and 74 (81.3%) cases were older than 46 y. Forty-six (50.5%) cases showed lymph node involvement, and 45 (49.5%) cases showed lymphoma at extranodal sites. In nodal lymphoma, staining was strongly positive for HDAC2, whereas staining was weak or negative for HDAC4; however, there was no significant correlation with survival. But nodal lymphoma cases with high nuclear expression of HDAC2 and nodal lymphoma cases with high nuclear expression of HDAC2 and low nuclear expression of HDAC4 showed significantly shorter survival times compared with other cases. CONCLUSIONS: High nuclear expression of HDAC2 may play an important role in survival of DLBCL patients, especially in those with nodal lymphoma, which is associated with a shorter survival time. Our results may have important implications for treatment of DLBCL by epigenetic regulation.